EP1722698B1 - Dispositif pour commander des structures corporelles - Google Patents

Dispositif pour commander des structures corporelles Download PDF

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Publication number
EP1722698B1
EP1722698B1 EP05715797A EP05715797A EP1722698B1 EP 1722698 B1 EP1722698 B1 EP 1722698B1 EP 05715797 A EP05715797 A EP 05715797A EP 05715797 A EP05715797 A EP 05715797A EP 1722698 B1 EP1722698 B1 EP 1722698B1
Authority
EP
European Patent Office
Prior art keywords
base plate
actuators
adjustment
target device
patient
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Active
Application number
EP05715797A
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German (de)
English (en)
Other versions
EP1722698A1 (fr
Inventor
Michael Vogele
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Seibersdorf Labor GmbH
Medical Intelligence Medizintechnik GmbH
Original Assignee
ARC Seibersdorf Research GmbH
Medical Intelligence Medizintechnik GmbH
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by ARC Seibersdorf Research GmbH, Medical Intelligence Medizintechnik GmbH filed Critical ARC Seibersdorf Research GmbH
Publication of EP1722698A1 publication Critical patent/EP1722698A1/fr
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Publication of EP1722698B1 publication Critical patent/EP1722698B1/fr
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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3403—Needle locating or guiding means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00367—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like
    • A61B2017/00398—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like using powered actuators, e.g. stepper motors, solenoids
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3403—Needle locating or guiding means
    • A61B2017/3405—Needle locating or guiding means using mechanical guide means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3403—Needle locating or guiding means
    • A61B2017/3405—Needle locating or guiding means using mechanical guide means
    • A61B2017/3409—Needle locating or guiding means using mechanical guide means including needle or instrument drives
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/70—Manipulators specially adapted for use in surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/10—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges for stereotaxic surgery, e.g. frame-based stereotaxis
    • A61B90/11—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges for stereotaxic surgery, e.g. frame-based stereotaxis with guides for needles or instruments, e.g. arcuate slides or ball joints
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/50—Supports for surgical instruments, e.g. articulated arms

Definitions

  • the invention relates to a device for controlling physical structures, in particular for introducing puncture needles or surgical probes.
  • Such a device according to the preamble of the first claim is in the basic concept of the WO 97/20515 the inventor known, this target device has proven in many surgical or stereotactic surgery with accurate control of points on or in the body.
  • modern computer technologies such as computerized tomography (CT)
  • CT computerized tomography
  • z. B. determined by CT patient data and parameters then an instrument to the defined target point on or in the body can be brought.
  • the target devices continue to be used in practice usually consist of a solid guide tube, which is attached to a stereotactic frame made of metal ironing or bow z. B. according to the US-A-52 57 998 . US-A-51 76 689 or US-A-52 01 742 , These devices do not fully meet the above requirements because these target devices with a heavy stereotactic frame make reproducible positioning very difficult. Stereotactic accuracy often suffers from repeated procedures, as the device needs to be changed for each patient. In addition, since the conventional aiming devices are tied to a massive frame, variability is often limited.
  • This also applies to the driving or approaching of the different entry locations with the target device suspended on this frame, in particular in the case of a stereotactic intervention, the individual body sections of the patient being reconstructed into a 3D object with corresponding stereotactic space coordinates on the processing computer and transferred to a monitor in the operating room become.
  • This virtual image is calibrated in the operating room to the patient with the aid of a passive mechanical arm coupled to the monitor, at the end of which there is a probe.
  • This patient calibration is done by approaching several points, z. B. anatomically significant points or by X-ray calibration points (markers) on the patient or on the calibration device. After appropriate correlation to the reconstructed 3D object on the screen, the computer is able to fit this 3D object into this virtual space.
  • the surgeon / surgeon can orient himself during the procedure by means of a reconstructed 3D object and several two-dimensional images, which always indicate the tip of the probe.
  • puncture needles are advanced directly into the tumor tissue to be irradiated and then a direct irradiation of the tumor by radioactive substances, starting from the needle tip.
  • the invention has for its object to provide a device for controlling physical structures that meets the above requirements, especially with a simple structure to create a precise, reproducible and variable guidance for medical instruments.
  • any spatial positioning and exact alignment of the target device is possible.
  • the actuators separately or alternatively alternately in their X and Y axes controlled or remotely controlled, so that the target device can be adjusted precisely and quickly by these actuators to allow a targeted adjustment of the target device in the spatial axes.
  • a very precise targeting of previously determined for example in CT intervention or target areas of rooms next to the operating room is possible, so that a significant reduction of radiation exposure of the surgical staff and a relief of the usual in neurosurgery interventions by the exact guidance of instruments , in particular puncture needles or surgical probes is achieved.
  • the arrangement of the actuators as flat boxes on top of each other and the patient cranked design of the adjusting arms since in this way the desired spatial points in the coordinate system, can be approached as reference planes similar to the imaging methods.
  • the target device in this case has in particular a guide tube with end-side ball heads in order to support the instruments as far as possible. This target device thus enables the insertion of the instruments in exact position adjustment to each other.
  • the fine positioning of the instruments can be done by the remotely controllable actuators from another room to reduce the radiation exposure of the staff in a radiotherapy in an advantageous manner.
  • a simulation can also be performed by e.g. the needle or probe tip is guided in the area of the stereotactic frame by means of the actuators, wherein the position in or on the virtual patient can be observed on the monitor.
  • a base plate 1 made of stainless, magnetizable steel is connected at its bottom to an operating table, For example, with metal claws that are bolted to the base plate 1.
  • the base plate 1 can be adjusted in relation to the operating table in the horizontal and in the vertical direction, with a high strength is ensured.
  • the parts of the holder that carry the aiming device 10 each consist of a base holder 2, holding rods 3 and 4 hingedly connected thereto, each having a bearing 5 for fastening actuators 6 for the aiming device 10 at the free end.
  • the base holder 2 can be anchored mechanically, magnetically or pneumatically at any point of the base plate 1, for which purpose a frame-like frame 1a is provided, which spans the patient.
  • the articulated connection of the support rods 3 and 4 can be fixed in each case by means of detents, for example with the hand grips shown here, so that the power transmission and thus the positional fixation of the actuators 6 is ensured with their movable in XY plane Verstellarmen 7.
  • a guide tube 9 for a medical instrument 8 for controlling a target tissue Z is mounted on ball heads 9a.
  • a probe or a storage tube for adaptation to the instrument 8 used can be introduced, in particular a provided with a stop for axial adjustment puncture needle 8, as shown here.
  • the axial position of the instrument 8 can also be exactly fixed by a clamping device.
  • the two base holders 2 or the frame 1a are prepositioned on the base plate 1 by means of markings 1b, then e.g.
  • the staff can leave the irradiation room and control the desired target point Z by remote control of the actuators 6 exactly.
  • the entry point and the entry direction of the target device 10 are thus finely adjusted by fine adjustment of the adjustment arms 7 in the XY plane.
  • the entire target device 10 in relation to the stereotactic frame 1 a and thus adjusted both to the calibration device and the patient exactly.
  • the patient is then fitted in exactly the same way in the frame 1 a, as he was scanned in CT.
  • the navigation system is now calibrated and the target device 10 in a stereotactically correct manner appropriate.
  • a probe can now be inserted again into the already adjusted aiming device 10 and, if necessary, the probe can be readjusted.
  • the readjustment if necessary, can be carried out quickly, since the probe already has almost the correct position due to the pre-adjustment and the instrument can be readjusted by the actuators 6 quickly and precisely to the destination Z.
  • the actuators 6 can thus move the adjusting arms 7 in the longitudinal and / or transverse direction, so that the guide tube 9 is arranged pivotable in almost every angular position and also displaceable to the target device 10 by the actuators 6 in the X and / or Y direction to move as well as to rotate their axes of rotation.
  • the target device 10 is here pivoted to the upper left in the inclined position shown.
  • the inserted into the guide tube 9 instrument 8 is also mitverschwenkt so that now can be controlled from the originally targeted goal Z another destination.
  • the lower actuator 6 could be moved transversely to the left to make the guide tube 9 steeper and thus achieve a millimeter accurate fine adjustment of the target direction of a relatively thin puncture needle.
  • the holder of the actuators 6 is shown in more detail. These are connected via the support rods 3 and 4 with ball joints with the base holders 2. The ball joints are locked by a lock is operated by means of the hand knob.
  • the spatial position of the guide tube 9 for guiding the instrument 8 can be set arbitrarily, with a sensitive adjustment is made possible by the actuators 6.

Landscapes

  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Medical Informatics (AREA)
  • Animal Behavior & Ethology (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Pathology (AREA)
  • Molecular Biology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Apparatus For Radiation Diagnosis (AREA)
  • Radiation-Therapy Devices (AREA)
  • Media Introduction/Drainage Providing Device (AREA)

Claims (5)

  1. Dispositif pour commander des structures corporelles, en particulier pour introduire des aiguilles de ponction ou des sondes opératoires, avec une plaque de fond (1), au moins un support de base (2) disposé sur la plaque de fond (1) et des tiges de maintien qui y sont fixées d'une manière articulée (3, 4) en vue du maintien et du positionnement d'un équipement cible (10) pour un instrument médical (8), caractérisé en ce que l'équipement cible (10) est logé sur deux bras de réglage (7), qui peuvent être déplacés dans le plan X-Y à chaque fois grâce à un dispositif de positionnement (6) à l'extrémité libre des tiges de maintien (3, 4) pré-positionnées avec un dispositif de logement (5), sachant que la plaque de fond (1) présente un cadre (1a) similaire à une charpente ou un portail et que les deux dispositifs de positionnement (6) sont disposés directement l'un sur l'autre, lesquels dispositifs sont réalisés de préférence sous la forme de boîtes plates, et sont prévues en vue du positionnement fin.
  2. Dispositif selon la revendication 1, caractérisé en ce que les bras de réglage (7) sont raccourcis en direction du patient.
  3. Dispositif selon la revendication 1 ou 2, caractérisé en ce qu'aux extrémités libres des arbres de réglage (7) est logé un tube de guidage (9) pour l'instrument médical (8), en particulier par l'intermédiaire de boules sphériques (9a).
  4. Dispositif selon la revendication 1, caractérisé en ce que la plaque de fond (1) présente des marquages (1b) en vue du repositionnement du cadre (1a), lesquels marquages peuvent être ancrés sur la plaque de fond (1) par voie magnétique, pneumatique ou mécanique.
  5. Dispositif selon l'une quelconque des revendications 1 à 4, caractérisé en ce que les dispositifs de positionnement (6) présentent chacun dans le plan X-Y un chariot à mouvements croisés pour le déplacement du bras de réglage (7) correspondant, en particulier avec des broches filetées, activables via télécommande.
EP05715797A 2004-03-06 2005-03-07 Dispositif pour commander des structures corporelles Active EP1722698B1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
DE202004003646U DE202004003646U1 (de) 2004-03-06 2004-03-06 Vorrichtung zur Ansteuerung körperlicher Strukturen
PCT/EP2005/002386 WO2005084565A1 (fr) 2004-03-06 2005-03-07 Dispositif pour commander des structures corporelles

Publications (2)

Publication Number Publication Date
EP1722698A1 EP1722698A1 (fr) 2006-11-22
EP1722698B1 true EP1722698B1 (fr) 2012-03-07

Family

ID=34917110

Family Applications (1)

Application Number Title Priority Date Filing Date
EP05715797A Active EP1722698B1 (fr) 2004-03-06 2005-03-07 Dispositif pour commander des structures corporelles

Country Status (7)

Country Link
US (1) US10206708B2 (fr)
EP (1) EP1722698B1 (fr)
JP (1) JP5050244B2 (fr)
AT (1) ATE547987T1 (fr)
CA (1) CA2558576C (fr)
DE (1) DE202004003646U1 (fr)
WO (1) WO2005084565A1 (fr)

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DE202015003206U1 (de) 2015-05-03 2016-05-10 Isys Medizintechnik Gmbh Vorrichtung zur Positionierung von sterilen lnstrumenten

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US10274553B2 (en) 2013-03-15 2019-04-30 Canon U.S.A., Inc. Needle placement manipulator with attachment for RF-coil
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DE102013111935A1 (de) * 2013-10-30 2015-04-30 Rg Mechatronics Gmbh Rahmen zum Halten eines Chirurgieroboters, Verwendung eines solchen Rahmens in einem Chirurgieroboter-System, sowie Chirurgieroboter-System mit einem solchen Rahmen
JP6467434B2 (ja) 2014-02-27 2019-02-13 ザ ブリガム アンド ウィメンズ ホスピタル インコーポレイテッドＴｈｅ Ｂｒｉｇｈａｍ ａｎｄ Ｗｏｍｅｎ’ｓ Ｈｏｓｐｉｔａｌ， Ｉｎｃ． 載置装置
US10251670B2 (en) 2014-05-09 2019-04-09 Canon U.S.A., Inc. Positioning apparatus
JP7045664B2 (ja) 2014-09-12 2022-04-01 ザ ブリガム アンド ウィメンズ ホスピタル インコーポレイテッド ニードル位置決め装置
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WO2017132505A1 (fr) 2016-01-29 2017-08-03 Canon U.S.A., Inc. Manipulateur de placement d'outil
US10695087B2 (en) 2016-10-19 2020-06-30 Canon U.S.A., Inc. Placement manipulator and attachment for positioning a puncture instrument
CN108283514A (zh) * 2018-03-22 2018-07-17 袁峰 一种三维椎间孔导向器
JP7332621B2 (ja) 2018-04-13 2023-08-23 アイシス メディツィンテクニック ゲーエムベーハー 医療ロボット
CN110946653B (zh) * 2018-12-29 2021-05-25 华科精准（北京）医疗科技有限公司 一种手术导航系统
CN114271917B (zh) * 2022-01-24 2023-12-26 山东第一医科大学(山东省医学科学院) 一种心血管造影装置

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Publication number Priority date Publication date Assignee Title
DE202015003206U1 (de) 2015-05-03 2016-05-10 Isys Medizintechnik Gmbh Vorrichtung zur Positionierung von sterilen lnstrumenten
WO2016177463A1 (fr) 2015-05-03 2016-11-10 Isys Medizintechnik Gmbh Dispositif de positionnement d'instruments stériles

Also Published As

Publication number Publication date
US10206708B2 (en) 2019-02-19
WO2005084565A1 (fr) 2005-09-15
CA2558576A1 (fr) 2005-09-15
EP1722698A1 (fr) 2006-11-22
JP2007527290A (ja) 2007-09-27
US20070276407A1 (en) 2007-11-29
ATE547987T1 (de) 2012-03-15
JP5050244B2 (ja) 2012-10-17
DE202004003646U1 (de) 2005-09-01
CA2558576C (fr) 2014-08-12

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